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Rates and predictors of relapse in first-episode non-affective psychosis: a 3-year longitudinal study in a specialized intervention program (PAFIP)

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Abstract

Relapses may represent a critical hazard in schizophrenia spectrum disorders as they are associated with an increased risk of a clinical and functional deterioration. Preventing relapse after recovering from a first psychotic episode has become a major challenge due to its critical impact on lifelong functionality. This study explored the rate of first and second relapses and the predictors associated with these relapses in a large cohort of non-affective psychosis patients during a period of 3 years after the first break of the illness. From February 2001 to May 2014, sociodemographic and clinical data from an epidemiological cohort of 341 non-affective first-episode psychosis patients at risk of relapse were analysed at a specialized early intervention service. Logistic regression, Cox regression, and Kaplan–Meier survival analyses were performed to compare non-relapsed and relapsed patients. One hundred and sixty-six (48.7%) individuals relapsed at least once. Median time to relapse was 17.0 months in non-adherent patients and 40.0 months in adherent patients (log-rankχ 2: 51.36; p < 0.001). Non-adherence to medication (odds ratio-OR 2.979; p < 0.001), schizophrenia diagnosis (OR 2.173; p = 0.002), and age of onset (OR 1.020; p = 0.033) were the main predictors of the first relapse. Fifty-six subjects experienced a second relapse (33.73%) predicted by diagnosis (OR 1.975; p = 0.074), age of onset (OR 1.078; p = 0.003), and positive symptoms (OR 0.863; p = 0.03), but not adherence. Non-adherence is the main predictive factor of first relapse after a first episode of psychosis. Second relapses were not often and not related to modifiable factors, suggesting that multiple relapsed patients may comprise a subgroup with a higher biological risk.

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Acknowledgements

The present study was carried out at the Hospital Marqués de Valdecilla, University of Cantabria, Santander, Spain, under the following grant support: Instituto de Salud Carlos III PI020499, PI050427, PI060507, Plan Nacional de DROGAS Research Grant 2005- Orden sco/3246/2004, SENY Fundació Research Grant CI 2005-0308007, Fundación Marqués de Valdecilla API07/011 and CIBERSAM. Unrestricted educational and research grants from AstraZeneca, Pfizer, Bristol-Myers Squibb, and Johnson & Johnson provided support to PAFIP activities. No pharmaceutical industry has participated in the study concept and design, data collection, analysis and interpretation of the results, and drafting the manuscript. PAFIP II is registered as a clinical trial (NCT02305823) in Clinicaltrials.gov: “Comparative Study of Aripiprazole, Quetiapine and Ziprasidone in the Treatment of First-Episode Non-affective Psychosis” (AZQ2005). The study, designed and directed by B C-F and JL V-B, conformed to international standards for research ethics and was approved by the local institutional review board. We wish to thank the PAFIP researchers who helped with data collection. In addition, we acknowledge the participants and their families for enrolling in this study.

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    Authors and Affiliations

    1. Department of Medicine and Psychiatry, University Hospital Marques de Valdecilla, School of Medicine, University of Cantabria-IDIVAL, Santander, Spain

      José María Pelayo-Terán, Virginia Gajardo Gajardo Galán, Víctor de la Ortiz-García de la Foz, Obdulia Martínez-García, Benedicto Crespo-Facorro & Rosa Ayesa-Arriola

    2. Centro Investigación Biomédica en Red Salud Mental (CIBERSAM), Santander, Spain

      José María Pelayo-Terán, Víctor de la Ortiz-García de la Foz, Obdulia Martínez-García, Rafael Tabarés-Seisdedos, Benedicto Crespo-Facorro & Rosa Ayesa-Arriola

    3. Complejo Hospitalario Universitario Infanta Cristina, Badajoz, Spain

      Virginia Gajardo Gajardo Galán

    4. Department of Medicine, Biomedical Research Institute INCLIVA, University of Valencia, Valencia, Spain

      Rafael Tabarés-Seisdedos

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    1. José María Pelayo-Terán
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    Correspondence to José María Pelayo-Terán.

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    Conflict of interest

    Dr. José María Pelayo-Terán has received lecture honoraria and travel support form Janssen Johnson & Johnson, Lundbeck, Otsuka Pharmaceuticals, GlaxoSmithkline and EiLilly. Prof. Benedicto Crespo-Facorro has received honoraria for consulting/advisory boards from Otsuka Pharmaceuticals and lecture honoraria from Janssen Johnson & Johnson, Lundbeck, Roche and Otsuka Pharmaceuticals. Prof. Rafael Tabarés-Seisdedos has received grants from or acted as a consultant for the following companies: AstraZeneca, Janssen, Eli- Lilly, Lundbeck, Novartis, Pfizer, Sanofi-Aventis, and Wyeth that were deposited into research accounts at the University of Valencia. Dr.Virginia Gajardo Gajardo Galán, Víctor de la Ortiz-García de la Foz, Obdulia Martín-García and Dr. Rosa Ayesa-Arriola report no additional financial support or other relationship relevant to the subject of this article.

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    José María Pelayo-Terán and Virginia Gajardo Gajardo Galán have contributed equally to this article.

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    Pelayo-Terán, J.M., Gajardo Galán, V.G., de la Ortiz-García de la Foz, V. et al. Rates and predictors of relapse in first-episode non-affective psychosis: a 3-year longitudinal study in a specialized intervention program (PAFIP). Eur Arch Psychiatry Clin Neurosci 267, 315–323 (2017). https://doi.org/10.1007/s00406-016-0740-3

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